A pure epidural spinal cavernous hemangioma - with an innocuous face but a perilous behaviour!!

Cavernous hemangiomas occur frequently in the intracranial structures but they are rare in the spine, with an incidence of 0.22 cases/million/year, which account for 5 - 12% of the spinal vascular lesions, 51% of which are extradural. Most of the epidural hemangiomas are secondary extensions from the vertebral lesions. The spinal cavernous hemangiomas which do not involve the vertebrae are referred to as "pure" types. The pure epidural hemangiomas are rare, which account for only 4% of all the epidural lesions. A case of a Pure spinal epidural cavernous hemangioma in a 50 year old male, with the clinical picture of a slowly progressive compressive myelopathy, has been presented here. The imaging studies showed a well-defined, enhancing epidural lesion at the T7 - T8 level, with dorsal cordedema and myelomalacic changes. A radiological diagnosis of a meningioma was considered. Histopathologically, the lesion was diagnosed as a hemangioma. The patient improved dramatically after the excision of the lesion.